68 Cards in this Set

A couple of first time parents come in with their 2 week old concerned that she weighs less than her birthweight. What do you do?

Reassure. It is okay to not gain weight within first 3 weeks of life.

What is the average birth length?

50 cm

50th percentile

Birth length goes up by 50% by what age?

It doubles by what age?

It triples by what age?

1 year

4 years

13 years

What is the normal head circumference for a term newborn?

35 cm

What is the growth rate for head circumference?

1 cm/month for 6 months and 0.5cm/month from 6 months to 1 year

Define Macrocephaly

Born with normal size head but progress to 98th percentile by six months. This is normal. Kids have normal development.

A 6 month is brought to you for a well visit. You note that the head circumference has gone from 50th percentile to 98th percentile. Development is normal. What do you do?

No workup. Measure parents heads.

A 2 month old presents with a large anterior fontanelle. His development is normal and has been feeding well. Physical exam is otherwise normal. What is your diagnosis? Next steps?

Macrocephaly. No further workup, except measure parents' heads.

What is Microcephaly?

Head Circumference > 3 SD below the mean for age and gender.

What is Acquired Microcephaly

Microcephaly presenting in child with normal presentation at birth.

A 3 month old is brought in for well visit. Your medical student notes that the head circumference has slipped down the growth curve while the weight and height remain normal. He would like to discharge the patient, is this okay?

No. Acquired Microcephaly needs a workup.

A child is brought to you in the ED because she has not been growing. The mom says she is giving her appropriate formula. What do you check next?

Observe mother/child interaction and feeding technique...AS INPATIENT

What are likely etiology in each case?
1. Decreased weight then length
2. Normal weight but short
3. Microcephalic and dysmorphic

1. Inadequate Caloric intake

2. Endocrine problem

3. Genetic chromosomal problem

5yo girl comes in for well visit. The nurse notes that the child is at normal height and weight but when you look at the curve you note she has only grown 3 cm over the last year. What do you do?

Evaluate for hypothyroidism and growth hormone deficiency because she has grown less than 5cm in one year.

You are presented with a 4yo who was at 50th percentile for ht and wt at birth but is now 25th for weight and below 5th for height. No family history of short stature. What is cause of short stature?

Growth Hormone Deficiency

What is "catchy phrase" for constitutional growth delay?

Parents have short stature

What is the "catchy phrase" for inadequate nutrition in short stature patient?

Weight is off the curve or not within normal range.

True or False
One must have either limitations in intellectual functioning or limitation in adaptive behaviour before age 18 to be called mentally retarded.

False. They must have limitations in both intellectual funtioning and adaptive behavior

What are the classifications of mental retardation and corresponding IQs.

Mild 50-69
Moderate 35-49
Severe 20-34
Profound <20

What is the best guage of cognitive function?
a. language
b. motor
c. social
d. fine motor

a. language

Child must visually fixate by what age?

2 months

Child must visually track and have steady head control by what age?

4 months

Child must turn to sound or voice by what age?

6 months

What age should you be worried if a child does not babble and can not sit?

9 months

At what age should you worry if a child can not walk independently?

18 months

At what age should you worry if a child does not use single words?

24 months

At what age would you worry if patient can not speak 3 word sentences?

36 months

At what age would you worry if a patient has unitelligible speech?

Older than 36 months

How do you diagnose autism?

Patient must present with one of the below before age 36 months
Serious social impairment
Delayed language development
Compulsive behaviours

What test must you do before diagnosing autism?

Hearing test

What one single criteria will rule out autism from the differential in pervasive development disorder.

Normal social interaction.

What distinguishes asperger's syndrome from the other pervasive development disorders?

Patient's have no speech or language or cognitive dysfunction. They ONLY have problems with social interaction.

What distinguishes Rett's syndrome from the other pervasive development disorders?

The child is normal for first year, then regresses.

True or False:
Social difficulty is considered a Learning Disorder.

False. It can be a manifestation of a learning disorder but not a disorder itself.

True or False: Learning disorders must present by the time the child is in elementary school.

False. They often don't present until the child is older, as kids can compensate in the early years.

True or False: A child can grow out of a learning disorder.

False.

You are seeing a 6yo patient for your collegue. The parents are teachers and are concerned that their daughter is dyslexic because she often mistakes her b and d when writing. What should you tell them?

Reassure them that it is normal for kids under 7 to confuse and reverse the letters b and d.

Define performance IQ and Verbal IQ.

What does it mean when one is significantly different than the other?

Performance IQ measures visual-spatial interpretation. Verbal IQ measures language based learning. A wide gap in the two is a hint that the child is at risk for a learning disorder.

What is the role of achievement testing?

Other than taking your money, they in theory distinguish between potential and actual IQ.

True or False: The predictive validity of IQ testing increases with age.

True.

At what age can a child throw a ball?

At what age can a child throw a ball overhand?

18 mos

24 mos

En ex-30 week preemie is now 8 weeks old. Her mother is concerned because the baby is not able to lift her head from a prone position. What do you do?

Reassure the mother. Preemies are expected to perform and grow at their corrected age. You can stop correcting at age 2yo.

I have a moro reflex, I can look at you but will follow only briefly. How old am I?

Full term newborn

I will look at you, follow you across the room with my eyes and lift my head and shoulders up while resting on my tummy, but can't really move on my own. How old am I?

2 mos old.

I will laugh and squeal if you entertain me. I will even prop myself up on my arms while on my tummy. I will try to entertain you by rolling from my tummy (prone) to my back (supine), but need help getting back to my tummy. If you hold me up on the table, I can stand and false step. If my hands are free I will reach for your glasses and anything else I can put in my mouth...even though I am not hungry. How old am I?

4 mos. old

I love to interact. I will turn to your voice and if you have anything in your hand, I will surely reach for it and if I get it, I will try to play hard to get and pass it back and forth in my hands. I will even talk in my own language and sit up with a backrest. And if I am lying, I will roll like a roly-poly. How old am I?

6 mos old

I love to sit up and bang blocks together or play pic-a-boo. I will turn to my name and say Mama-Dada but I really don't know what those words mean. I do know who my family is and get anxious around strangers. How old am I?

9 mos old.

I love going surfing. And when I come back to rest I sit back and say Mama or Dada and immediately my mommy or daddy appears with a cup filled with my favorite drink and feeds it to me, while I hold between my fingers a small sea shell that I picked up on the beach. After I'm done, I help my daddy dress me, but when my sister calls my name and motions for me to go to her, I surf on over!

I am 1 year old. and Life is Good!

Life is not as good anymore. Mom says I have to walk on my own now and I have to drink by myself now. And even worse, today I dropped my sea shell and I had to stoop down, pick it up, stand up and put it in a cup. Since I can still only speak a 3-6 words, I tried writing, but that was only a scribble. I can point to my nose and I do like passing the ball back and forth with my sister. I guess that's good. How old am I now?

15 months

So I was mouthing off my 10-20 words that I learned, and mom took my hand and walked me up the stairs to my room. I built a tower of two blocks, but I also made a mess, so then I had to vacuum the floor. When she finally brought me down for lunch, she wouldn't even feed me. I had to feed myself. So I threw a fit and threw the ball. I got in a little trouble, but Mommy is still cool. How old am I?

18 months

My Dad was so proud of me. I built a tower of 4 blocks. I made everyone laugh by dropping a raisin in my milk bottle. How old am I?

16-19 months

I am getting good! I built a tower of 6 blocks today. I was so proud, I jumped up and down and kicked the ball down the steps. Then I took off my clothes and I washed and dried my hands. I got in trouble for that. I can speak about 50 words now and my favorite word is "me." People who don't know me say they don't understand half of what I am saying. How old am I?

24 months

Mommy says I am turning into a chatterbox now, and people can understand almost everything I say. This morning after breakfast I went up the stairs by myself and put on a shirt and shorts for school. In school, I copied a circle and a line with my crayon. Me and my friend Suzy rode our tricycles around the block. Then we stood on one foot to see who could stand longest. We both started laughing cause we could only do it for a couple seconds.

3 years old

Daddy calls me Curious George because I keep asking so many questions. I have to get dressed and brush my teeth. Suzy is coming over again. I think we will play airport today. We both love going up and down the stairs. We are getting better at standing on one foot now. And we can draw a person and know 4 colors. How old are we?

4 years old

I know what silly means. It means I am acting funny. I can count to 5 now and I can draw a person with a head, eyes, nose, mouth, arms, and legs. I am making cereal before I go play board games with Suzy today. How old am I?

Five years old

Hooray I get to ride my bike to school. I need to make sure and tie my shoes so I don't fall. I have to turn left and then right and then we will be at school. Look, there are ten kids wearing the same uniform as me. That's why I have to write my name on my sticker. How old am I?

Six years old.

At what age can kids draw the following shapes:
Circle
Square
Triangle
Diamond
Cross

3 yo
5 yo
6 yo
7 yo
4 yo

A child is brought in for a well visit. The parents are both professors at Hopkins and are very distraught because their 4 year old stutters. Who do you refer them to?

No one. You reassure them. Stuttering is normal until school age.

At what age can a child build a tower of:
2-3 blocks?
4-6 blocks?
8 blocks?

18 mos
24 mos
36 mos

A 3 yo child who is of a bilingual family only has a vocabulary of 20 words. The family feels that this is not a big deal because the child is bilingual. For the boards, is this true?

No. This is not an excuse for delayed speech.

A 2 year old is brought to your office because she is not speaking any clear words. You find out that she had neonatal meningitis and hyperbilirubinemia. What is your next step?

Do a hearing screen.

What are risk factors for delayed or absent language development?

Risk factors are TORCH infections, hyperbilirubinemia, meningitis.

True or False:
Children may be diagnosed with ADHD if the level of inattention and activity is greater than that expected for their MENTAL age as determined by IQ.

True. For example, if a 10-year-old boy has an intelligence quotient of 60, he would be expected to have the attention span and activity level of a 6-year-old.

Which child would MOST benefit from a non-stimulant medication?
A) an inattentive child
B) a hyperactive child
C) a child with both

B

True or False:
A one-to-one aide usually is not necessary for children who have levels of hyperactivity and inattention typical of ADHD.

True. A one to one aide is most beneficial for kids who have destructive behavior or autism or cerebral palsy

Physical examination results are normal for a 2-year-old girl during a health supervision visit. She follows two-step commands, speaks 10 words, points to pictures that you name, and sorts objects by color. She uses a spoon well, but does not use a fork. She plays alongside other children but does not share toys. Her mother would like to know if she should be concerned about the girl's development.

Of the following, your BEST response is that her daughter
A) has normal development
B) is delayed in her expressive language skills
C) is delayed in her fine motor skills
D) likely has a hearing impairment
E) needs more social interaction with other kids